What does this research mean for the field?

In contemporary US clinical practice, hospitalized heart failure patients experience significant gaps in prehospitalization guideline-directed medical therapy (GDMT), with only modest post-discharge improvements, delayed initiation, and high discontinuation rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the adherence to guideline-directed medical therapy (GDMT) for heart failure in hospitalized patients.

March 12, 2026

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Contemporary Guideline-Directed Medical Therapy for Heart Failure in the United States: The EMPACE Study.

SGStephen J Greene AAAtif AdamIQVIA (United Kingdom)NSNiklas SchmedtBoehringer Ingelheim (China)

Key Result

In hospitalized HFrEF patients, prehospitalization quadruple therapy was significantly lacking, with only modest improvements in GDMT and high discontinuation rates post-discharge.

Key Points

This research aims to evaluate the adherence to guideline-directed medical therapy (GDMT) for heart failure in hospitalized patients.
Analyzed treatment patterns among patients hospitalized for HFrEF in the US.
Assessed the initiation and continuation rates of quadruple therapy pre- and post-discharge.
Examined similar patterns with SGLT2 inhibitors (SGLT2i) for HFmrEF and HFpEF.
Significant gaps in prehospitalization quadruple therapy were identified.
Only modest improvements in GDMT were seen after discharge.
Delayed initiation and high discontinuation rates of therapy were common.

Structured PICO

What are the contemporary utilization patterns of guideline-directed medical therapy among patients hospitalized for heart failure in the United States?

Population

Patients hospitalized for HFrEF, HFmrEF, and HFpEF in contemporary US clinical practice

Intervention

Guideline-Directed Medical Therapy (GDMT) including quadruple therapy and SGLT2 inhibitors

Outcome

GDMT utilization patterns (prehospitalization use, post-discharge improvement, initiation, and discontinuation rates)

Despite established guidelines, there are significant gaps in the initiation and maintenance of guideline-directed medical therapy for heart failure in contemporary US practice.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Among patients hospitalized for HFrEF in contemporary US clinical practice, there were significant gaps in prehospitalization quadruple therapy and only modest GDMT improvement post-discharge, with delayed initiation and high discontinuation rates. Similar patterns were observed with SGLT2i among patients with HFmrEF and HFpEF.

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Cite This Study

Greene et al. (Tue,) reported a other. In hospitalized HFrEF patients, prehospitalization quadruple therapy was significantly lacking, with only modest improvements in GDMT and high discontinuation rates post-discharge.

synapsesocial.com/papers/69b25b4996eeacc4fcec9e2c https://doi.org/https://doi.org/10.1161/jaha.125.044785

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